Community Healthcare Worker (Remote)

Job Opportunity

Efforts focused on medical, behavioral, and social determinants of health factors that improve the well-being of individuals, families, and communities.

Job Description: As a key member of our care team, you will engage with members in person—either at a facility or in a community setting—as well as virtually over the phone. You will support members by assessing their overall health and wellness, helping them set meaningful goals, and guiding them toward healthier lifestyles through personalized, compassionate care. Key responsibilities include:

• Establishing meaningful connections with members through face-to-face or telephonic interactions.
• Conducting comprehensive assessments that address members' biopsychosocial, functional, and behavioral health needs.
• Applying motivational interviewing techniques to help members uncover intrinsic goals and inspire positive behavior change.
• Practicing active listening to gather relevant information and respond dynamically during assessments.
• Encouraging active participation in the assessment process and collaboratively developing individualized plans of care that reflect each member's goals, needs, and preferences.
• Identifying urgent or high-risk situations and escalating appropriately to ensure timely intervention.
• Partnering with members to define health goals and identify barriers that may impact goal achievement.
• Providing education on health and wellness topics to support self-management and improved outcomes.
• Working collaboratively with members to develop practical solutions to overcome barriers to care.
• Identifying and connecting members to appropriate community resources based on identified needs.
• Presenting complex case details to the interdisciplinary care team and integrating their input into care plans as needed.
• Utilizing computer applications to document and share member-related information.
• Accurately and promptly documenting assessments, interactions, referrals, and follow-up plans in relevant systems.
• Staying current with updates and changes to computer systems and effectively applying knowledge in day-to-day work.
• Meeting or exceeding performance metrics within a virtual, productivity-driven environment.

Requirements: Deep passion and commitment to supporting individuals with complex medical, behavioral, or social needs. Bachelor's degree in Social Work, or license as a Licensed Practical Nurse (LPN), Certified Nursing Assistant (CNA), or Home Health Aide (HHA) preferred. Alternatively, a high school diploma or equivalent with a minimum of 3 years of experience in a community health or healthcare setting, or demonstrated experience using motivational interviewing techniques. Must be fully vaccinated against COVID-19. Proficiency with Microsoft Office products, particularly Word and Outlook; ability to quickly learn and navigate clinical or member-related applications. A dedicated, private home workspace with secure, high-speed internet access via cable or DSL. Valid driver's license, active auto insurance, and reliable transportation for occasional field visits to members, hospitals, or community locations. Residency within the Philadelphia, PA area is required. Preferred qualifications: Bilingual proficiency (spoken and written). Formal training or demonstrated skill in motivational interviewing.